PSA Rising

It was a freak accident – Fred Thomforde of Knoxville had just hooked the ball to the left and down a hill. Upset over the shot, he hopped into his golf cart and sped toward the ball.

But when he pressed the brakes, the cart began sliding on the wet grass. “Like some kind of fool, I stuck my foot out to stop it, and boom! Hit a bump, went up in the air and came down with my groin on the handle,” Thomforde recounted.

While it hurt and caused some bruising to the 70-year-old retired attorney, he didn’t think much about it until later that evening when blood in his urine prompted him to seek medical attention, a decision that not only would change his life but save it as well.

For it was at that visit to his primary care doctor, Dr. Michael Passarello, in 2008, that he was referred to Dr. Edward Tieng, an urologist at Fort Sanders Regional Medical Center – a decision that ultimately led to Tieng’s early detection of prostate cancer.

Dr. Tieng determined Thomforde’s golf cart injury was not serious but because of the blood in the urine and because Thomforde had been a smoker, the doctor moved cautiously. He ordered a test to determine the amount of prostate-specific antigen (PSA) in Thomforde’s blood. That test came back with a PSA score of .8 nanograms per milliliter – well within the normal range.

“I think the ‘danger zone’ is something like 2 and above,” Thomforde said of the PSA score. “I never got into the danger zone, but early in 2010, Dr. Tieng said, ‘They are still normal, but these levels are rising.’ He wanted to check it again in three months.”

Three months later, the PSA level was still within the normal range, but Thomforde was asked to return yet again. “I’m still in the normal range,” he said. “I started out at .8 but now I’m at 1.8. So we had a long talk.”

It was during that “talk” that Dr. Tieng recommended Thomforde undergo a biopsy, a procedure in which 12 core samples were removed from the prostate gland by a needle. The biopsied tissue was then sent to a laboratory and “graded” by a pathologist who assigned it a Gleason score, a scoring system of 2 to 10 used to describe the cells’ appearance. A score of 2 to 4 indicates the cells appear normal, 5 to 7 indicates intermediate risk of prostate cancer and 8 to 10 indicates an aggressive form of prostate cancer. Thomforde’s Gleason score was 7.

To determine whether Thomforde’s prostate cancer had spread, Dr. Tieng ordered CT and bone scans. When the imaging indicated that his cancer was contained to the prostate, Dr. Tieng presented Thomforde with his options.

“By this time, I had a good relationship with Dr. Tieng and had complete confidence in him – he’s a very likable person but very professional,” said Thomforde.

“He explained to me the various options – there’s radiation treatment, hormone treatments, and so forth – and I finally said to him, ‘I will defer to your judgment on this’ and he said, ‘If I were you in your particular condition and health, I would recommend surgery.’ I didn’t even think about it. I just said, ‘Let’s do it.’”

In an almost 3-hour minimally invasive procedure, Dr. Tieng used Fort Sanders’ da Vinci robot to remove Thomforde’s cancerous prostate gland. The pathologist later confirmed that Thomforde was cancer-free.

“My hospital experience was excellent, my recovery was excellent: Nurses, technicians, lab people, the doctors, the whole experience to me was first rate,” said Thomforde. “My PSA never got into the ‘danger zone’ per se but Dr. Tieng made a judgment based on his personal history with me. Rather than just keep going with the PSA, he went with the biopsy and it caught the cancer while it was confined to the prostate. Early detection made all the difference.”